When I was presented with the opportunity to write this post, I spent some time looking into topics that would fit well with this blog. During my search, I came across the question, “Do people who are ‘only trying to help’ sometimes make things worse?” I found this question especially relevant to the work that my students in the UVA Wise Pre-Professional Club and I are trying to do in our local communities.

From the time we are young, we are taught that we should always help others and be kind to everyone. That’s kindergarten basics, but the issue arises when someone asks us how we intend to help. When becoming actively involved in underprivileged and underserved communities, we often run the risk of coming across as clumsy or disconnected from reality and the nuances of the lives that the members of that community live on the day to day. There’s a phrase from Fresh Prince in which Will says, “He’s a little confused, but he’s got the spirit.” Sometimes spirit, that simple yet compassionate desire to do good, is not enough. We must understand the roots of the issues we hope to resolve before we can actually make progress toward a solution. We have to take the time to ask why things are the way they are, and only then can we identify the how.

All of the problems we face have context, and as scientists and medical professionals, sometimes we lose the ability to see that context. We use words like “community engagement” and “public health activism” without understanding the real origins of need. We have to start asking the correct questions, rather than assuming that we already have all the answers. In many communities, what appears on the surface to be a lack of interest may actually be fear or distrust. In medicine, we often become detached from the fundamental truths of the profession, which is that we are here to serve. Practicing medicine is a privilege, and privilege is derived from trust. Trust, like most things in life, must first be earned.

My students will someday go out into the world and become doctors. As a scientific educator, they continue to ask why and how. As I teach them and watch them grow, my goal will always be the same: I want to help them become better.

Tori Makal, PhD (they/them)
Assistant Professor of Biochemistry
University of Virginia’s College at Wise

“You are going to have to quit eating.”

“If your A1C indicates that you’ve been eating carbs, I won’t be able to continue treating you.”

It is not hard to imagine the adverse outcomes for patients if these strategies were adopted to manage their diabetes. Like diabetes, opioid use disorder (OUD) is a chronic disease. The treatment trajectory for patients suffering from OUD often includes multiple relapses. Most management strategies prioritize abstinence, which often leads to “firing” the patient from care when relapse is detected which creates barriers to successful treatment.

Super-potent illicitly manufactured opioids like fentanyl are flooding the streets. While we quickly see the impact of such agents through the marked increase in opioid overdose mortality, we are likely not yet seeing the impact that the pharmacokinetics of these drugs have on morbidity. The central actions of these highly potent agents are terminated by distribution out of the brain, which means these agents have much shorter pharmacodynamic half-lives than less potent agents. The shorter duration of action leads to more frequent need for dosing, which in turn leads to an increase in risk for infectious diseases.   

Integration of harm-reduction strategies into the outpatient management of patients suffering from OUD will improve the quality of life, reduce risks for patients, and reduce the potential for spread of resistant pathogens. Harm reduction incorporates humanism, pragmatism, patient-centered care, autonomy, and pragmatism through accountability without discharge from care ^{1, 2}. Evidence-based harm reduction interventions include¹:

• Provide treatment on demand, with accommodation for late-shows and walk-ins
• Provide non-judgmental patient-centered care
• Reduce stigma during patient encounters
• Prevent, detect, and treat infections
• Provide harm-reduction supplies including items such as intranasal naloxone, syringes, sterile water for injection, and condoms
• Teach patients sterile technique

We need to begin treating opioid use disorder like a chronic disease rather than a moral issue.

Mary Beth Babos, PharmD, BCPS
Professor of Pharmacology & Chair of Pharmacology
DeBusk College of Osteopathic Medicine
Lincoln Memorial University

1. Taylor, J. L., Johnson, S., Cruz, R., Gray, J. R., Schiff, D., & Bagley, S. M.  Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings : Harm Reduction in Outpatient Addiction Treatment. Journal of general internal medicine, 2021;36(12): 3810–3819. doi: 10.1007/s11606-021-06904-4.

2. Hawk M, Coulter RWS, Egan JE, et al. Harm reduction principles for healthcare settings. Harm Reduct J. 2017;14(1):70. doi: 10.1186/s12954-017-0196-4.

“Go ahead and push the etomidate.”

A few moments later, after administering the short-acting anesthetic and putting in a breathing tube, I toss the MAC blade away, listen for breath sounds, and give a thumbs-up to the intensivist peeking through the glass door.

I came into residency scared, only because I thought I was supposed to be. I was a new doctor with real responsibility and real people to take care of. In reality, I wasn’t that scared. I knew what I was getting into, and I’m fortunate to be in a very supportive program. Don’t get me wrong, there have been scary moments. I’ve run codes, given life-altering news, and lost patients I deeply cared about. I’ve done procedures, changed EMRs, and even consulted on a pregnant patient as an internal medicine resident. During all those nerve-wracking moments, I knew that I always had one of my medical mentors there to back me up. I’ve been blessed with what I consider some of the best teachers and attendings in the world. Knowing that they were there to validate my decisions and to be a safeguard gave me great confidence. A confidence that is likely to be quite short-lived.

As it turns out, the scariest part of residency isn’t your first intubation attempt with a pulmonologist looking over your shoulder. It’s not your first STEMI (heart attack) admission when a cardiologist has already ordered anti-platelets. It’s not even a rapid response during your first night shift when you know the nocturnist will be there by the time you can get a manual blood pressure. The scariest part of residency is when—after two and a half years of intense, supervised, training—you look up and realize that in a few months there won’t be anyone peeking through the glass door.

Rand Wasson, DO
PGY-3, Co-Chief Resident, Internal Medicine
Johnston Memorial Hospital

I am Haley Sykes, a junior at The University of Virginia’s College at Wise. I am a Cell and Molecular Biology major with hopes of becoming a doctor one day. My twin sister, Kaley, also wants to become a doctor.

This year we have had the wonderful opportunity to volunteer with the Graduate Medical Education Consortium of Southwest Virginia through our school’s pre- professional club. Over the past 3 months we have had the opportunity to meet and connect with families from Inman Village.

My sister and I attended the October event where we handed out fresh produce donated from a UVa Wise professor who gleans at local farms. Then we helped plan and run the November event, which talked about how to buy healthy food cheaply in the area.

For December’s program, the Christmas Market was scheduled during the college’s winter break and we were already home. That did not stop us from driving the extra hour to help out. We are also in the middle of studying for the MCAT and that very day we also had a meeting with admissions from a medical school. We made the drive to Inman quizzing each other on MCAT questions.

Despite having a full plate, we enjoy volunteering in the community, and were very excited for the Christmas Market. We helped plan it, and over the last few visits to Inman, Kaley and I had formed strong connections with the children.

The Christmas Market consisted of locally donated items of all kinds ranging from toys and games to clothes and decorations. Each child was asked to pay one dollar for an entry fee to gain some responsibility; parents we asked in October and November said they wanted the kids to pay something. In addition, all proceeds were donated back to the church that so graciously hosted us. We want to thank the Inman Baptist Chapel for allowing us to use their sanctuary and kitchen for the event, Each child was allowed to pick out 12 items for gifts for their family and friends, including one for themselves. 

We had a very great turn out with about 50 children attending the event along with their parents. Kaley and I also prepared the chicken casserole meal for the night; we did it the night before. After the kids shopped, their parents and they were able to eat the meal in the kitchen, or take it to go.

Kaley and I had a wonderful time helping out. We got to personally help the kids pick gifts for people on their list and help them wrap each gift. It was very rewarding when the children walked in the church and shouted our names. They had remembered us from previous trips and some could even tell us twins apart. We look forward to seeing them again in the future and continuing to volunteer with the GME Consortium.